Inappropriate imprisonment of the mentally ill

Following three months of debate in every branch in England and Wales, delegates at the WI national conference in Liverpool voted overwhelmingly - 6,205 in favour and 173 against - to call a halt to the inappropriate imprisonment of the mentally ill.

This heralds the start of a powerful WI campaign which will see ministers, MPs, courts, health and prison authorities called upon to introduce far reaching reforms.

WI resolution

In view of the adverse effect on families of the imprisonment of people with severe mental health problems, this resolution urges HM Government to provide treatment and therapy in a more appropriate and secure residential environment.

National Federation of Women’s Institutes

Speech by Juliet Lyon, director of the Prison Reform Trust

It is difficult to think of anywhere more likely to make the mentally ill worse and drive some people to despair than the bleak, impersonal environment of an overcrowded prison. Last year alone 92 people committed suicide in prison and over 20,000 harmed themselves repeatedly. 

In her recent review of mental health in prisons, the Chief Inspector of Prisons, Anne Owers, concluded “that prison has become, to far too large an extent, the default setting for those with a wide range of mental and emotional disorders.” Some mental health experts believe that the under-resourcing of health reforms in the late 80s and early 90s has contributed to the rapid rise in prison numbers.  The prison population in England and Wales has soared from just under 45,000 in 1990 to almost 83,000 today. An estimated 5,000 people at any one time are thought to be too ill to be there.

The impact incarceration has on people with mental health problems and their families is often overlooked.  Many families find it difficult to support and to maintain contact with relatives as they are moved on from one overcrowded prison to the next. Those families able to stay in touch often feel helpless and very distressed as they watch family members struggle to cope with the dual problems of mental illness and imprisonment.

This resolution was formed by the mother of a very ill young man who ended his life in prison. Richard was doing a doctorate in physics when he suffered a breakdown and was diagnosed with schizophrenia. After this he spent years in mental healthcare. On one occasion he was brandishing a toy pistol and threatening to harm himself. His sister called the police who, because they knew him, were able to take him to hospital where his condition was stabilised. But when an almost identical incident happened in another part of the country, this time he was arrested and eventually given a five year sentence. Richard’s mother, said:

Richard did not cope well with prison.  Care for the mentally ill should be therapeutic and in surroundings conducive to peace and recovery – not the barred, noisy, stressful and gardenless prison.  Those of you who have visited prisons will be aware of how unpleasant and entirely unsuitable a place they are for the mentally ill.  Prisons spend more than half their NHS health budget on mental health care.  They have health care units, employ psychiatric nurses and have in-reach teams – who do their best, but prison can never be appropriate for the mentally ill.  His treatment was drug based.  He was locked up for up to 15 hours a day and had only 2 hours of “association” where he was bullied and treated with suspicion by most of his fellow prisoners.

Richard wrote to his mother:

You must understand that one of my beliefs, at a deep level, is that the world is a dangerous and malevolent place – this is common with my illness.  As a result, I do assume that everyone is out to get me... You can see that I am in a terrible situation, segregated, hated by the entire jail it seems and not knowing what will happen next.  Someone could come to my door at any time and tell me I am off to some alien jail, unwanted by this establishment, only to find myself clawing out some kind of existence amongst a new set of threatening criminals.  I hate this kind of life and I have considered actual suicide.  I am by myself and the cell is cold.

She received this letter after Richard’s death. It is a tribute to Richard’s mother, and her quiet and dignified determination that other families should not have to suffer in the way hers has, that we are debating this resolution today. Something good could come out of this tragedy.

In many ways the resolution is not contentious. The inappropriate imprisonment of people who are mentally ill has been strongly criticised by the chief inspector of prisons and by professional bodies including the British Medical Association, the Royal Colleges of Nursing and of Psychiatry, the Prison Governors’ and the Prison Officers’ Associations. Children’s charities are united in opposing the imprisonment of mentally ill children. We have been proud at the Prison Reform Trust to partner with penal affairs and mental health charities to inform the WI debate leading up to the AGM.

But the gaps in mental health care have long been identified and cannot be tackled without significant ministerial commitment and investment. Changing NHS practice and policy is difficult and appropriate care of the mentally ill may take a long time to achieve. Even where significant improvements have been made the courts are not always aware of the mental health treatment options open to them.

The problems we have been discussing are complicated and need complex solutions. Following proper assessment, a range of services need to be commissioned to match a range of needs - from those who need a safe or secure environment through to the many people who can manage well in the community if they receive proper support and supervision and often treatment for addictions as well. Ann Widdecombe, former prisons minister, who gave this resolution her full backing when she spoke to the Cornwall Federation in April, warned members that it could take five years or more to see it implemented.

So where are the seeds of hope and how can the WI succeed in changing things? There are signs of cross party agreement and political will. The All Party Parliamentary Groups on Mental Health and on Penal Affairs have issued calls for the development of a national network of diversion schemes at police stations and courts. Select Committees on Welsh Affairs, Human Rights and Justice are all taking the matter up. The government has commissioned Lord Bradley to undertake a review of the scope for diversion from the criminal justice system for people who are mentally ill or have learning disabilities. After the six deaths of young women at Styal prison Baroness Corston was asked to conduct a review. Almost all of her recommendations for health and community measures to deal with most of the vulnerable women who offend have been accepted in principle. The question now is will government put them into practice?

And this is where informed pressure is needed - to gather information about the adequacy of existing health services, to call upon ministers, constituency MPs, local councils, the courts and primary care trusts to play their part, to make sure that people are informed about the state of our prisons and the state of many people in them and to enlist public support for change. There are examples of good practice that can be found. Right here in Liverpool the mental health team based in Liverpool Magistrates’ Court provides a comprehensive care service for clients with serious mental health problems in the criminal justice system. It is able to divert people away from the criminal justice system when appropriate and liaise with community services and prisons to ensure good aftercare as well as providing training for the police. Healthcare has been shown not only to improve well being but also to cut reoffending rates.

It is wrong to lock up some of our most ill citizens in our most neglected institutions. And it doesn’t have to be like this.

You can read and download the WI resolution notes here